nicotine Oral, Transdermal

NIK-oh-teen

Commonly used brand name(s)

In the U.S.

• Habitrol


• Nicoderm CQ


• Nicotrol

In Canada

• Nicoderm

Available Dosage Forms:

• Patch, Extended Release

Therapeutic Class: Smoking Cessation Agent

Pharmacologic Class: Cholinergic

Uses For nicotine

Nicotine, in a flavored chewing gum, a lozenge, or a skin patch, is used to help you stop smoking. It is used for up to 12 weeks as part of a stop-smoking program. This program may include education, counseling, and psychological support.

As you chew nicotine gum or suck on the nicotine lozenge, nicotine passes through the lining of your mouth and into your blood stream. When you wear a nicotine patch, nicotine passes through your skin into your blood stream. This nicotine takes the place of nicotine that you would otherwise get from smoking. In this way, the withdrawal effects of not smoking are less severe. Then, as your body adjusts to not smoking, the use of the nicotine gum is decreased gradually until use is stopped altogether. For most brands of patches, the strength of the patch you use will be decreased over a few weeks until use is stopped. If you are using the brand of patch that is available in only one strength, use is stopped after the treatment period indicated on the label.

Children, pregnant women, and nonsmokers should not use nicotine gum or patches because of harmful effects.

Nicotine transdermal patches, gum, and lozenges are available without a prescription.

Before Using nicotine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For nicotine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to nicotine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Small amounts of nicotine can cause serious harm in children. Even nicotine patches that have been used still contain enough nicotine to cause problems in children. Although there is no specific information comparing use of nicotine in teenagers with use in other age groups, nicotine is not expected to cause different side effects or problems in nicotine-dependent teenagers than it does in adults.

Geriatric

Nicotine gum, lozenges, and patches have been used in a limited number of patients 60 years of age or older, and have not been shown to cause different side effects or problems in older people than in younger adults.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	D	Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using nicotine.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking nicotine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using nicotine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Clozapine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of nicotine. Make sure you tell your doctor if you have any other medical problems, especially:

• Dental problems (with gum only) or


• Diabetes, type 1 (sugar diabetes) or


• Heart or blood vessel disease or


• High blood pressure or


• Inflammation of mouth or throat (with gum only) or


• Irritated skin (with patches only) or


• Overactive thyroid or


• Pheochromocytoma (PCC) or


• Stomach ulcer or


• Stroke, recent or


• Temporomandibular (jaw) joint disorder (TMJ) (with gum only)—Nicotine may make the condition worse.

Proper Use of nicotine

For patients using the chewing gum:

• Nicotine gum usually comes with patient directions. Read the directions carefully before using nicotine.


• Use nicotine gum exactly as directed on the label. Remember that it is also important to participate in a stop-smoking program during treatment. This may make it easier for you to stop smoking.


• When you feel the urge to smoke, chew one piece of gum very slowly until you taste it or feel a slight tingling in your mouth. Stop chewing, and place (“park”) the chewing gum between your cheek and gum until the taste or tingling is almost gone. Then chew slowly until you taste it again. Continue chewing and stopping (“parking”) in this way for about 30 minutes in order to get the full dose of nicotine.


• Do not chew too fast, do not chew more than one piece at a time, and do not chew more than one piece of gum within an hour. To do so may cause unpleasant side effects or an overdose. Also, slower chewing will reduce the possibility of belching.


• You should not drink acidic beverages, such as citrus fruit juices, coffee, soft drinks, or tea within 15 minutes before or while chewing a piece of gum. The acid will prevent the nicotine from being released from the gum.


• As your urge to smoke becomes less frequent, gradually reduce the number of pieces of gum you chew each day until you are chewing three to six pieces a day. This may be possible within 2 to 3 months.


• Remember to carry nicotine gum with you at all times in case you feel the sudden urge to smoke. One cigarette may be enough to start you on the smoking habit again.


• Using hard sugarless candy between doses of gum may help to relieve any nicotine cravings you may have between doses of gum.

For patients using the lozenge:

• Nicotine lozenges usually come with patient directions. Read the directions carefully before using nicotine.


• Use nicotine lozenges exactly as directed on the label. Remember that it is also important to participate in a stop-smoking program during treatment. This may make it easier for you to stop smoking.


• Do not eat or drink for 15 minutes before using a nicotine lozenge.


• When you feel the urge to smoke, suck one lozenge slowly until it dissolves. Do not bite or chew the lozenge like a hard candy. Do not swallow the lozenge.


• As your urge to smoke becomes less frequent, gradually reduce the number of lozenges you use each day until you are using three to six lozenges a day. This should be possible within 12 weeks.


• Remember to carry nicotine lozenges with you at all times in case you feel the sudden urge to smoke. One cigarette may be enough to start you on the smoking habit again.

For patients using the transdermal system (skin patch):

• Nicotine patches usually come with patient instructions. Read them carefully before using nicotine. Nicotine patches will work only if applied correctly.


• Remember that it is also important to participate in a stop-smoking program during treatment. This may make it easier for you to stop smoking.


• Do not remove the patch from its sealed pouch until you are ready to put it on your skin. The patch may not work as well if it is unwrapped too soon.


• Do not try to trim or cut the adhesive patch to adjust the dosage. Check with your doctor if you think the medicine is not working as it should.


• Apply the patch to a clean, dry area of skin on your upper arm, chest, or back. Choose an area that is not very oily, has little or no hair, and is free of scars, cuts, burns, or any other skin irritations.


• Press the patch firmly in place with the palm of your hand for about 10 seconds. Make sure there is good contact with your skin, especially around the edges of the patch.


• The patch should stay in place even when you are showering, bathing, or swimming. Apply a new patch if one falls off.


• Rinse your hands with plain water after you have finished applying the patch to your skin. Nicotine on your hands could get into your eyes and nose and cause stinging, redness, or more serious problems. Using soap to wash your hands will increase the amount of nicotine that passes through your skin.


• After 16 or 24 hours, depending on which product you are using, remove the patch. Choose a different place on your skin to apply the next patch. Do not put a new patch in the same place for at least 1 week. Do not leave the patch on for more than 24 hours. It will not work as well after that time and it may irritate your skin.


• After removing a used patch, fold the patch in half with the sticky sides together. Place the folded, used patch in its protective pouch or in aluminum foil. Make sure to dispose of it out of the reach of children and pets.


• Try to change the patch at the same time each day. If you want to change the time when you put on your patch, just remove the patch you are wearing and put on a new patch. After that, apply a fresh patch at the new time each day.


• Nicotine patches should be removed from the skin during strenuous exercise. If a patch is left on, too much nicotine may pass through your skin into your blood stream.


• If you are using a 24-hour patch and begin having unusual dreams or disturbed sleep, you may take the patch off before going to bed and put a new one on after you wake up the next morning.

Dosing

The dose of nicotine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of nicotine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For the oral dosage form (chewing gum):
  
  • To help you stop smoking:
    
    • Adults and teenagers—The usual dose is one piece of chewing gum every one to two hours for six weeks, one piece of chewing gum every two to four hours for three weeks, then one piece of chewing gum every four to eight hours for three weeks. You should not chew more than 24 pieces of gum a day.
    
    
    • Children—Use and dose must be determined by your doctor.
    
    
  
  


• For the oral dosage form (lozenge):
  
  • To help you stop smoking:
    
    • Adults and teenagers—The usual dose is suck slowly one lozenge until it dissolves every one to two hours for six weeks, suck one lozenge every two to four hours for three weeks, then suck one lozenge every four to eight hours for three weeks. You should not use more than 20 lozenges a day.
    
    
    • Children—Use and dose must be determined by your doctor.
    
    
  
  


• For the transdermal (stick-on) skin patch:
  
  • To help you stop smoking:
    
    • Adults and teenagers—The dose you receive will be based on your body weight, how often you have the urge to smoke, and the brand and strength of the patch you use. This dose will be provided on the package label.
    
    
    • Children—Use and dose must be determined by your doctor.
    
    
  
  

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using nicotine

Do not smoke during treatment with nicotine gum, lozenges, or patches because of the risk of nicotine overdose.

Nicotine should not be used in pregnancy. If there is a possibility you might become pregnant, you may want to use some type of birth control. If you think you may have become pregnant, stop using nicotine immediately and check with your doctor.

Nicotine products must be kept out of the reach of children and pets. Even nicotine patches that have been used still contain enough nicotine to cause problems in children. If a child chews or swallows one or more pieces of nicotine gum or lozenges, contact your doctor or poison control center at once. If a child puts on a nicotine patch or plays with a patch that is out of the sealed pouch, take it away from the child and contact your doctor or poison control center at once.

For patients using the chewing gum:

• Do not chew more than 24 pieces of gum a day. Chewing too many pieces may be harmful because of the risk of overdose.


• Do not use nicotine gum for longer than 12 weeks. To do so may result in physical dependence on the nicotine. If you feel the need to continue using the gum after 12 weeks, contact your doctor.


• If the gum sticks to your dental work, stop using it and check with your medical doctor or dentist. Dentures or other dental work may be damaged because nicotine gum is stickier and harder to chew than ordinary gum.

For patients using the lozenges:

• Do not use more than 20 lozenges a day. Sucking too many pieces may be harmful because of the risk of overdose.


• Do not use nicotine lozenges for longer than 12 weeks. If you feel the need to continue using the lozenges after 12 weeks, contact your doctor.

For patients using the transdermal system (skin patch) :

• Mild itching, burning, or tingling may occur when the patch is first applied, and should go away within 24 hours. After a patch is removed, the skin underneath it may be red. It should not remain red for more than a day. If you get a skin rash from the patch, or if the skin becomes swollen or very red, call your doctor. Do not put on a new patch. If you become allergic to the nicotine in the patch, you could get sick from using cigarettes or other products that contain nicotine.


• Do not use nicotine patches for longer than 12 weeks if you have stopped smoking. If you feel the need to continue using nicotine patches after 12 weeks, contact your doctor.


• The patch may cause skin burns when used during a procedure called magnetic resonance imaging (MRI). To prevent skin burns, make sure the patch is removed before having an MRI .

nicotine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common

• Injury or irritation to mouth, teeth, or dental work—with chewing gum only

Less common

• High blood pressure

Rare

• Fast or irregular heartbeat


• hives, itching, rash, redness, or swelling of skin

Symptoms of overdose (may occur in the following order)

• Nausea and/or vomiting


• increased watering of mouth (severe)


• abdominal or stomach pain (severe)


• diarrhea (severe)


• pale skin


• cold sweat


• headache (severe)


• dizziness (severe)


• disturbed hearing and vision


• tremor


• confusion


• weakness (severe)


• extreme exhaustion


• fainting


• low blood pressure


• difficulty in breathing (severe)


• fast, weak, or irregular heartbeat


• convulsions (seizures)

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Belching—with chewing gum and lozenges


• headache (mild)


• increased appetite


• increased watering of mouth (mild)—with chewing gum only


• jaw muscle ache—with chewing gum only


• redness, itching, and/or burning at site of application of patch—usually stops within 24 hours


• sore mouth or throat—with chewing gum only

Less common or rare

• Abdominal or stomach pain (mild)


• change in sense of taste


• constipation


• coughing (increased)


• diarrhea


• dizziness or lightheadedness (mild)


• drowsiness


• dryness of mouth


• hiccups—with chewing gum and lozenges


• hoarseness—with chewing gum only


• indigestion (mild)


• loss of appetite


• menstrual pain


• muscle or joint pain


• nausea or vomiting (mild)


• passing of gas


• sweating (increased)


• trouble in sleeping or unusual dreams


• unusual irritability or nervousness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: nicotine Oral, Transdermal side effects (in more detail)

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More nicotine Oral, Transdermal resources

• Nicotine Oral, Transdermal Side Effects (in more detail)
• Nicotine Oral, Transdermal Use in Pregnancy & Breastfeeding
• Nicotine Oral, Transdermal Drug Interactions
• Nicotine Oral, Transdermal Support Group
• 42 Reviews for Nicotine Oral, Transdermal - Add your own review/rating

Compare nicotine Oral, Transdermal with other medications

• Smoking Cessation

Co-phenotrope 2.5 / 0.025 tablets

1. Name Of The Medicinal Product

Lomotil tablets (POM)

Dymotil tablets (P)

Co-phenotrope 2.5/0.025 tablets

2. Qualitative And Quantitative Composition

Each tablet contains 2.5mg of diphenoxylate hydrochloride BP and 0.025mg of atropine sulphate Ph.Eur

3. Pharmaceutical Form

White tablet with “GS10” engraved on one side

4. Clinical Particulars

4.1 Therapeutic Indications

POM product

Adults and children:

Adjunctive therapy to appropriate rehydration in acute diarrhoea

Control of stool formation after colostomy or ileostomy

Relief of symptoms in chronic and mild ulcerative colitis (see warning)

P product

Adults only (aged 16 years and over):

Adjunctive therapy to appropriate rehydration in acute diarrhoea

4.2 Posology And Method Of Administration

Route of administration

Oral

Caution: The recommended dosage should not be exceeded. Once satisfactory control is achieved, dosage should be reduced to suit the requirements of the individual patients.

POM product

Adults:

The recommended starting dosage is four tablets followed by two tablets every six hours.

Elderly:

Consideration should be given to the presence of other diseases and concomitant drug therapy ( see precautions)

Children:

Recommended dosage guide:

Under 4 years:- Not recommended

4-8 years:- 1 tablet three times daily

9-12 years:- 1 tablet four times daily

13-16 years:- 2 tablets three times daily

P product

Adults:

The recommended starting dose is four tablets followed by two tablets every six hours. The maximum dose is 10 tablets in the first 24 hours and 8 tablets in 24 hours thereafter. This should not be exceeded.

Elderly:

The dose is as for adults. Consideration should be given to the presence of other disease and concomitant therapy (see precautions).

Children:

Not for use in children under 16 years of age.

4.3 Contraindications

POM product

Lomotil is contraindicated in patients with known hypersensitivity to diphenoxylate hydrochloride or atropine, in patients with jaundice, intestinal obstruction, acute ulcerative colitis, in the treatment of diarrhoea associated with pseudomembranous enterocolitis, and in patients with a raised intracranial pressure, and patients with head injury.

Contraindicated in myasthenia gravis, pyloric stenosis, paralytic ileus and prostatic enlargement.

P product

Dymotil is contraindicated in patients with a known hypersensitivity to diphenoxylate hydrochloride or atropine, in patients with jaundice, intestinal obstruction, any inflammatory bowel disease, including all forms of ulcerative colitis, and in the treatment of diarrhoea associated with pseudomembranous enterocolitis. Dymotil is also contraindicated in patients with Down's syndrome, and in patients with a raised intracranial pressure, and patients with head injury.

Contraindicated in myasthenia gravis, pyloric stenosis, paralytic ileus and prostatic enlargement.

4.4 Special Warnings And Precautions For Use

Appropriate fluid and electrolyte therapy should be given to protect against dehydration. If severe dehydration or electrolyte imbalance is present, the medicine should be withheld until appropriate corrective therapy has been initiated. In some patients with ulcerative colitis, agents which inhibit intestinal mobility or delay intestinal transit time have been reported to induce toxic megacolon. Patients with ulcerative colitis should be observed carefully and Lomotil therapy should be discontinued promptly if abdominal distension or other untoward symptoms develop.

The medicine should be used with extreme caution in patients with advanced hepatorenal disease, and in patients with abnormal liver function, since hepatic coma may be precipitated.

Because a subtherapeutic dose of atropine is added to the medicine, atropine effects may occur in susceptible individuals or in overdosage. Individuals with Down's syndrome appear to have increased susceptibility to the action of atropine.

Additionally for the P Product

If symptoms persist for more than 24 hours, the patient should consult a doctor. Dymotil is for the symptomatic relief of acute diarrhoea, and is not a substitute for rehydration therapy.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

The following interaction have to be considered in the use of Lomotil Tablets:-

Lomotil antagonises the effect of Domperidone, Metoclopramide, Bethanecol/Carbachol, Cisapride, Galantamine, Neostigmine/pyridostigmine, and Pilcarpine.

The amtimuscarinic side effects of Lomotil are increased by Amantadine, Anthihistamines (sedative and non-sedative), Clozapine, Disopyramide, Fluspiriline, Loxapine, MAOI's, Nefopam, Olanzapine, Phenothiazines, Quantiapine, Remoxipride, Terfenadine, Tricyclic antidepressasnts, and Zotepine.

Dry mouth prevents the dissolution of sublingual nitrate tablets, such as glyceryl trinitrate.

The effect of Lomotil is antagonised by Dompezil.

The effect of Lomotil is increased by Memantine.

Lomotil may reduce the plasma levels of Levodopa (in combination and sole products).

Lomotil reduces the absorption of Ketoconazole.

4.6 Pregnancy And Lactation

POM product

Pregnancy

Animal teratology and reproduction studies have demonstrated no adverse effects. The safety of Lomotil in human pregnancy has not been established. However, as with all drugs, caution is recommended when used in early pregnancy.

Lactation

Diphenoxylate hydrochloride and atropine sulphate may be excreted in human milk. If a nursing mother is taking Lomotil, the infant may exhibit some effects of the drug.

P product

Pregnancy and Lactation

Dymotil should not be used during pregnancy and in nursing mothers.

4.7 Effects On Ability To Drive And Use Machines

Some of the undesirable effects such as sedation, drowsiness or dizziness may affect the ability to drive or operate machines. If affected, patients should be advised not to drive or operate machinery.

4.8 Undesirable Effects

The side effects of Lomotil Tablets include malaise, lethargy, sedation, somnolence, confusion, dizziness, restlessness, depression, euphoria, hallucinations, headache, and fever.

Anaphylaxis, angioedema, urticaria and pruritus have been reported side effects.

Gastrointestinal side effects include paralytic ileus, toxic megacolon, nausea, vomiting, abdominal discomfort, constipation and anorexia.

The atropine side effects of Lomotil Tablets include flushing, dryness of the skin and mucous membranes (including dry mouth), cardiac irregularities such as arrhythmias, bradycardia, and palpitations, increased intra-ocular pressure, urinary retention and difficulty in micturition, and respiratory depression in children.

Dilation of pupils with loss of accommodation, photophobia and very rarely angle closure glaucoma can occur.

4.9 Overdose

Accidental overdose may produce narcosis with respiratory depression or atropine poisoning or both, particularly in children. Symptoms of overdose include dryness of the skin and mucous membranes, flushing, hypothermia and tachycardia, nystagmus, pinpoint pupils, hypotonic reflexes, lethargy, coma, and sever respiratory depression. The onset of symptoms of overdose may be considerably delayed and respiratory depression may not become evident until as late as 12-30 hours after ingestion, and may occur in spite of initial response to narcotic antagonists. Continuous observation should be maintained for at least 48 hours.

If respiratory depression develops, naloxone, a specific antidote, should be administered. The duration of action of naloxone hydrochloride is considerably shorter than that of diphenoxylate hydrochloride and repeated injections of the antidote may be required. Establishment of a patient airway and artificial ventilation may be needed. If the patient is not comatose, gastric ravage and administration of slurry of an activated charcoal may be indicated.

5. Pharmacological Properties

5.1 Pharmacodynamic Properties

The active ingredient diphenoxylate hydrochloride is a synthetic opioid derivative with selective effects on gastrointestinal smooth muscle. It is essentially devoid of “morphine type subjective effects” at therapeutic doses.

Atropine sulphate is included in the formulation as an anti-abusing agent contributing to the safe use of the product. The dose of atropine sulphate contained in each tablet is subtherapeutic therefore a pharmaceutical effect due to atropine should not be detected taken at normal therapeutic doses.

5.2 Pharmacokinetic Properties

Diphenoxylate hydrochloride is well absorbed from the gastrointestinal tract and extensively metabolised in the liver to diphenoxylic acid (diphenoxin), and hydroxydiphenoxylic acid. It is excreted mainly as metabolites in the urine and bile.

5.3 Preclinical Safety Data

Diphenoxylate hydrochloride is a well established pharmaceutical active and is the subject of a pharmacopoeial monograph. No specific preclinical studies have therefore been performed.

6. Pharmaceutical Particulars

6.1 List Of Excipients

Lomotil/Dymotil tablets contain:

Sucrose

Acacia

Sorbitol

Magnesium stearate

Talc

Light liquid paraffin

6.2 Incompatibilities

None known

6.3 Shelf Life

The shelf life of Lomotil/Dymotil tablets is 5 years when stored in blister packs.

6.4 Special Precautions For Storage

Store in a dry place below 30°C

6.5 Nature And Contents Of Container

POM

Lomotil tablets are supplied in PVC/PVDC/Aluminium foil blister packs of 100, 500, and 1000 tablets.

P

Dymotil tablets are supplied in PVC/PVDC/Aluminium foil blister packs of 20.

6.6 Special Precautions For Disposal And Other Handling

None

7. Marketing Authorisation Holder

Goldshield Pharmaceuticals Ltd

NLA Tower

12 - 16 Addiscombe Road

Croydon

Surrey

CR0 0XT

8. Marketing Authorisation Number(S)

PL 12762/0040

9. Date Of First Authorisation/Renewal Of The Authorisation

01/11/1999 / 12/05/2004

10. Date Of Revision Of The Text

17 August 2010

Nuedexta

Generic Name: dextromethorphan and quinidine (DEX troe meth OR fan and KWIN i deen)

Brand Names: Nuedexta

What is dextromethorphan and quinidine?

Dextromethorphan affects the signals in the brain that trigger cough reflex and is generally used as a cough suppressant.

Quinidine affects the way that the heart beats and is generally used to in people with certain heart rhythm disorders.

The combination of dextromethorphan and quinidine is used to treat involuntary outbursts of crying or laughing in people with certain neurological disorders, including multiple sclerosis and amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease).

Dextromethorphan and quinidine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about dextromethorphan and quinidine?

You should not take dextromethorphan and quinidine if you are also taking quinidine (Quin-G), quinine (Qualaquin), or mefloquine (Lariam), or if you have ever had an allergic reaction or serious medical problem caused by taking any of these medications. You should not use this medication if you are allergic to dextromethorphan or quinidine, or if you have heart failure, a serious heart condition called "AV block" (unless you have a pacemaker), or a history of Long QT syndrome or life-threatening heart rhythm disorder.

Before you take this medication, tell your doctor if you have slow heartbeats or any other type of heart rhythm disorder, an electrolyte imbalance, bladder or bowel obstruction, myasthenia gravis, or a family history of Long QT syndrome.

There are many other drugs that can cause serious or life threatening medical problems if you take them together with dextromethorphan and quinidine. Tell your doctor about all other medicines you use. Do not start a new medication without telling your doctor.

What should I discuss with my healthcare provider before taking dextromethorphan and quinidine?

You should not take this medicine if you are also taking quinidine (Quin-G), quinine (Qualaquin), or mefloquine (Lariam), or if you have ever had hepatitis, low levels of platelets in your blood, bone marrow depression, lupus-like syndrome, or an allergic reaction caused by taking any of these medications. You should not use this medication if you are allergic to dextromethorphan or quinidine, or if you have:

• 
  

  heart failure;

  
  


• 
  

  a history of life-threatening heart rhythm disorder;

  
  


• 
  

  a history of Long QT syndrome; or

  
  


• 
  

  a serious heart condition called "AV block" (unless you have a pacemaker).

  
  

Do not use dextromethorphan and quinidine if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

After you stop taking dextromethorphan and quinidine, you must wait at least 14 days before you start taking an MAOI.

There are many other drugs that can cause serious or life threatening medical problems if you take them together with dextromethorphan and quinidine. The following drugs should not be used while you are taking dextromethorphan and quinidine:

• 
  

  an anti-malaria drug called chloroquine (Aralen);

  
  


• 
  

  certain antidepressants: amitriptyline (Elavil, Vanatrip, Limbitrol), clomipramine (Anafranil), or desipramine (Norpramin);

  
  


• 
  

  certain heart rhythm medications: quinidine (Quin-G), procainamide (Procan, Pronestyl), or propafenone, (Rythmol); or

  
  


• 
  

  certain medicines to treat psychiatric disorders: chlorpromazine (Thorazine), haloperidol (Haldol), pimozide (Orap), or thioridazine (Mellaril).

  
  

If you cannot avoid taking any of the medicines listed above, your heart function may need to be tested on a regular basis while you are taking dextromethorphan and quinidine. Do not miss any follow-up visits to your doctor.

To make sure you can safely take this medicine, tell your doctor if you have any of these other conditions:

• 
  

  a family history of Long QT syndrome;

  
  


• 
  

  an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  
  


• 
  

  slow heartbeats or any type of heart rhythm disorder;

  
  


• 
  

  myasthenia gravis;

  
  


• 
  

  bladder obstruction or other urination problems; or

  
  


• 
  

  a bowel obstruction or intestinal disorder.

  
  

FDA pregnancy category C. It is not known whether dextromethorphan and quinidine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether this medication passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give dextromethorphan and quinidine to anyone under 18 years old without medical advice.

How should I take dextromethorphan and quinidine?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Dextromethorphan and quinidine is usually started at a dose of 1 capsule per day for 7 days. After the first week you will take 1 capsule every 12 hours. Follow your doctor's instructions. Do not take more than 2 capsules in a 24-hour period.

You may take dextromethorphan and quinidine with or without food.

Your doctor will need to check your progress on a regular basis. This will help your doctor determine how long to treat you with dextromethorphan and quinidine. To be sure the medicine not causing harmful effects, your heart function may need to be checked using an electrocardiograph or ECG (sometimes called an EKG). This machine measures electrical activity of the heart. Visit your doctor regularly. Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose can cause severe dizziness, confusion, double vision, ringing in your ears, vomiting, rapid heart rate, weak or shallow breathing, a dazed feeling, or seizure (convulsions).

What should I avoid while taking dextromethorphan and quinidine?

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Grapefruit and grapefruit juice may interact with dextromethorphan and quinidine and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.

Ask a doctor or pharmacist before using any cough or cold medication. Dextromethorphan is contained in many combination medicines. Taking certain products together can cause you to get too much dextromethorphan. Check the label to see if a medicine contains dextromethorphan (Delsym, Robitussin Maximum Strength, Vicks 44, and others).

Dextromethorphan and quinidine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using dextromethorphan and quinidine and call your doctor at once if you have a serious side effect such as:

• 
  

  severe dizziness, fainting, fast or pounding heartbeat;

  
  


• 
  

  easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  
  


• 
  

  pain or burning when you urinate;

  
  


• 
  

  fever, chills, flu symptoms, nausea, vomiting, feeling light-headed;

  
  


• 
  

  nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  
  


• 
  

  agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting; or

  
  


• 
  

  joint pain or swelling with fever, swollen glands, muscle aches, nausea, vomiting, chest pain, unusual thoughts or behavior, and/or seizure (convulsions).

  
  

Less serious side effects may include:

• 
  

  muscle spasm;

  
  


• 
  

  diarrhea, gas, mild stomach pain;

  
  


• 
  

  dizziness, weakness;

  
  


• 
  

  cough; or

  
  


• 
  

  swelling in your hands or feet.

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect dextromethorphan and quinidine?

Tell your doctor about all other medicines you use, especially:

• 
  

  aprepitant (Emend);

  
  


• 
  

  cimetidine (Tagamet);

  
  


• 
  

  digoxin (Lanoxin, Lanoxicaps);

  
  


• 
  

  narcotic cough medicine (codeine or dihydrocodeine);

  
  


• 
  

  ADHD medication such as atomoxetine (Strattera), dextroamphetamine (Adderall), methamphetamine (Desoxyn), methylphenidate (Ritalin, Daytana, Metadate, Concerta);

  
  


• 
  

  an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), citalopram (Celexa), desipramine (Norpramin), doxepin (Sinequan), duloxetine (Cymbalta), fluoxetine (Prozac, Sarafem, Symbyax), nortriptyline (Pamelor), nefazodone, paroxetine (Paxil), sertraline (Zoloft), or venlafaxine (Effexor);

  
  


• 
  

  an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), doxycycline (Doryx, Oracea, Periostat, Vibramycin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), metronidazole (Flagyl), norfloxacin (Noroxin), telithromycin (Ketek), or tetracycline (Ala-Tet, Brodspec, Panmycin, Sumycin, Tetracap);

  
  


• 
  

  antifungal medicine such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), miconazole (Oravig), or voriconazole (Vfend);

  
  


• 
  

  cancer medicine such as doxorubicin (Adriamycin, Doxil), lomustine (CeeNU), tamoxifen (Soltamox);

  
  


• 
  

  heart or blood pressure medication such as amiodarone (Cordarone, Pacerone), betaxolol (Kerlone), captopril (Capoten), carvedilol (Coreg), diltiazem (Cartia, Cardizem), flecainide (Tambocor), labetalol (Normodyne), metoprolol (Dutoprol, Lopressor, Toprol), mexilitene (Mexitil), nicardipine (Cardene), pindolol (Visken), propranolol (Inderal), timolol (Blocadren), verapamil (Calan, Covera, Isoptin, Verelan), and others;

  
  


• 
  

  HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), efavirenz (Sustiva, Atripla), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase), or ritonavir (Norvir, Kaletra); or

  
  


• 
  

  pain medication such as codeine (Tylenol #3), hydrocodone (Lortab, Vicodin, Vicoprofen), oxycodone (OxyContin, Percocet), or tramadol (Ultram, Ultracet).

  
  

This list is not complete and there are many other drugs that can interact with dextromethorphan and quinidine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

More Nuedexta resources

• Nuedexta Side Effects (in more detail)
• Nuedexta Use in Pregnancy & Breastfeeding
• Nuedexta Drug Interactions
• Nuedexta Support Group
• 3 Reviews for Nuedexta - Add your own review/rating

• Nuedexta Prescribing Information (FDA)


• Nuedexta Advanced Consumer (Micromedex) - Includes Dosage Information


• Nuedexta MedFacts Consumer Leaflet (Wolters Kluwer)


• Nuedexta Consumer Overview

Compare Nuedexta with other medications

• Pseudobulbar Affect

Where can I get more information?

• Your pharmacist can provide more information about dextromethorphan and quinidine.

See also: Nuedexta side effects (in more detail)

Tozaar

Tozaar may be available in the countries listed below.

Ingredient matches for Tozaar

Losartan

Losartan potassium salt (a derivative of Losartan) is reported as an ingredient of Tozaar in the following countries:

• Myanmar

International Drug Name Search

Neutrogena T/Gel

Generic Name: coal tar topical (KOL TAR TOP ik al)

Brand Names: Balnetar, Betatar Gel, Coal Tar, Cutar, Denorex, Denorex Dry Scalp, Denorex Extra Strength, Denorex Medicated Shampoo and Conditioner, DHS Tar Shampoo, Doak Tar, Doak Tar Oil, Elta Tar, Fototar, G-TAR, Ionil T, Ionil T Plus, MG 217 Psoriasis, MG217 Medicated Tar, Neutrogena T/Derm, Neutrogena T/Gel, Neutrogena T/Gel Extra Strength, Oxipor VHC, PC Tar, Pentrax, Pentrax Gold, Polytar, Psoriasin, Psorigel, T/Gel Conditioner, Tegrin Medicated, Tegrin Medicated Soap, Therapeutic, Theraplex T, Zetar

What is coal tar?

Coal tar is a by-product of coal processing.

Coal tar topical (for the skin) is used to treat the skin symptoms of psoriasis, including dryness, redness, flaking, scaling, and itching. Coal tar is not a cure for psoriasis, and it will provide only temporary relief of skin symptoms.

Coal tar may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about coal tar?

You should not use this medication if you are allergic to coal tar.

Before using coal tar, tell your doctor if you are allergic to any drugs, or if you are receiving ultraviolet radiation treatment for your psoriasis.

Do not use coal tar to treat the skin of your groin or rectal area.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Coal tar can make your skin more sensitive to sunlight and sunburn may result. Stop using coal tar and call your doctor at once if you have severe stinging, burning, swelling, or other irritation of the treated skin. Do not use coal tar to treat large skin areas. Do not use coal tar over long periods of time without your doctor's advice.

Call your doctor if your symptoms do not improve, or if they get worse after using coal tar.

Coal tar is not a cure for psoriasis, and it will provide only temporary relief of skin symptoms.

What should I discuss with my health care provider before using coal tar?

You should not use this medication if you are allergic to coal tar.

Before using coal tar, tell your doctor if you are allergic to any drugs, or if you are receiving ultraviolet radiation treatment for your psoriasis.

This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether coal tar passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Coal tar products may contain lanolin, mineral oil, or other emulsifiers. Check the label of any coal tar product you are using. Talk with your doctor before using coal tar if you are allergic to any of the ingredients.

How should I use coal tar?

Use this medication as directed on the label, or as your doctor has prescribed. Do not use the medication in larger amounts or for longer than recommended.

Apply coal tar cream, lotion, ointment, or solution according the directions on the medication label. Some forms of coal tar may be applied 1 to 4 times per day.

To use coal tar bath oil, pour 1 to 3 capfuls into a warm bath before bathing. The oil can make the bathtub slippery. Take care to avoid a fall.

Shake the coal tar shampoo well just before each use. Use enough shampoo to create a rich lather. Massage the shampoo into your scalp and rinse thoroughly. Apply the shampoo a second time and leave it on your scalp for 5 minutes. Rinse thoroughly. Do not use coal tar to treat large skin areas. Do not use coal tar over long periods of time without your doctor's advice.

Call your doctor if your symptoms do not improve, or if they get worse after using coal tar.

Coal tar shampoo may discolor blond or colored hair. This effect is usually temporarily.

Some forms of coal tar can stain fabric or other surfaces.

Store coal tar at room temperature away from moisture and heat. Keep the medicine tightly closed with not in use.

What happens if I miss a dose?

Use the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a coal tar overdose are not known.

What should I avoid while using coal tar?

Avoid getting this medication in your eyes. If this does occur, rinse with water.

Do not use coal tar to treat the skin of your groin or rectal area.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Coal tar can make your skin more sensitive to sunlight and sunburn may result.

Coal tar side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using coal tar and call your doctor at once if you have severe stinging, burning, swelling, or other irritation of the treated skin.

Less serious side effects may include mild skin irritation or skin rash.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect coal tar?

Do not use coal tar together with other psoriasis medications unless your doctor tells you to.

There may be other drugs that can interact with coal tar. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

More Neutrogena T/Gel resources

• Neutrogena T/Gel Use in Pregnancy & Breastfeeding
• Neutrogena T/Gel Support Group
• 0 Reviews for Neutrogena T/Gel - Add your own review/rating

• Neutrogena T/Gel Topical Advanced Consumer (Micromedex) - Includes Dosage Information


• Coal Tar Foam MedFacts Consumer Leaflet (Wolters Kluwer)


• Denorex Shampoo MedFacts Consumer Leaflet (Wolters Kluwer)


• Doak Tar Shampoo MedFacts Consumer Leaflet (Wolters Kluwer)


• Fototar Ointment MedFacts Consumer Leaflet (Wolters Kluwer)


• MG217 Medicated Tar Lotion MedFacts Consumer Leaflet (Wolters Kluwer)


• Psoriasin Prescribing Information (FDA)

Compare Neutrogena T/Gel with other medications

• Dermatitis
• Psoriasis
• Seborrheic Dermatitis

Where can I get more information?

• Your pharmacist can provide more information about coal tar.

Biaxin

In the US, Biaxin (clarithromycin systemic) is a member of the drug class macrolides and is used to treat Bacterial Endocarditis Prevention, Bronchitis, Dental Abscess, Helicobacter Pylori Infection, Legionella Pneumonia, Mycobacterium avium-intracellulare - Prophylaxis, Mycobacterium avium-intracellulare - Treatment, Mycoplasma Pneumonia, Nongonococcal Urethritis, Otitis Media, Pharyngitis, Pneumonia, Sinusitis, Skin Infection, Strep Throat, Toxoplasmosis and Upper Respiratory Tract Infection.

US matches:

• Biaxin


• Biaxin Suspension


• Biaxin XL Extended-Release Tablets


• Biaxin XL


• Biaxin XL-Pak


• Biaxin Filmtab

Ingredient matches for Biaxin

Clarithromycin

Clarithromycin is reported as an ingredient of Biaxin in the following countries:

• Canada


• Germany


• Luxembourg


• United States

International Drug Name Search

Next Choice

Generic Name: levonorgestrel emergency contraceptive (LEE voe nor jes trel)

Brand Names: Next Choice, Plan B, Plan B One-Step

What is Next Choice (levonorgestrel emergency contraceptive)?

Levonorgestrel is a female hormone that prevents ovulation (the release of an egg from an ovary). This medication also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Levonorgestrel emergency contraceptive is used to prevent pregnancy after unprotected sex or failure of other forms of birth control (such as condom breakage, or missing 2 or more birth control pills).

Levonorgestrel emergency contraceptive may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Next Choice (levonorgestrel emergency contraceptive)?

Do not use this medication if you are already pregnant. Levonorgestrel emergency contraceptive will not terminate a pregnancy that has already begun (the fertilized egg has attached to the uterus). Levonorgestrel emergency contraceptive is not intended for use as a routine form of birth control and should not be used in this manner. Talk with your doctor about the many forms of birth control available. Do not give this medication to anyone younger than 17 years old. Contact a doctor for medical advice.

What should I discuss with my healthcare provider before taking Next Choice (levonorgestrel emergency contraceptive)?

Levonorgestrel emergency contraceptive is not intended for use as a routine form of birth control and should not be used in this manner. Talk with your doctor about the many forms of birth control available. Do not use this medication if you are already pregnant. Levonorgestrel emergency contraceptive will not terminate a pregnancy that has already begun (the fertilized egg has attached to the uterus).

Before using this medication, tell your doctor if you are allergic to any drugs, or if you have diabetes. You may not be able to use levonorgestrel emergency contraceptive, or you may need special tests during treatment.

Levonorgestrel can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medication to anyone younger than 17 years old. Contact a doctor for medical advice.

How should I take Next Choice (levonorgestrel emergency contraceptive)?

Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger amounts or for longer than recommended.

The first dose of levonorgestrel emergency contraceptive must be taken as soon as possible after unprotected sex (no later than 72 hours afterward). The second dose must be taken 12 hours after the first dose. The timing of these doses is very important for this medication to be effective.

Call your doctor right away if you vomit within 1 hour after taking either dose of levonorgestrel emergency contraceptive. Do not take another dose until you talk with your doctor.

You should be examined by your doctor within 3 weeks after taking levonorgestrel emergency contraceptive. The doctor will need to confirm that you are not pregnant and that this medication has not caused any harmful effects.

If your period is late by 1 week or longer after the expected date, you may be pregnant. Get a pregnancy test and contact your doctor if you are pregnant. Levonorgestrel emergency contraceptive will not terminate a pregnancy that has already begun (the fertilized egg has attached to the uterus).

Store levonorgestrel emergency contraceptive at room temperature away from moisture and heat.

See also: Next Choice dosage (in more detail)

What happens if I miss a dose?

Missing a dose of this medication increases your risk of being pregnant.

Contact your doctor if you miss a dose of levonorgestrel emergency contraceptive. The timing of these doses is very important for this medication to be effective.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include nausea and vomiting.

What should I avoid while taking Next Choice (levonorgestrel emergency contraceptive)?

Levonorgestrel emergency contraceptive will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases. Avoid having unprotected sex.

Next Choice (levonorgestrel emergency contraceptive) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have severe pain in your lower stomach or side. This could be a sign of a tubal pregnancy (a pregnancy that implants in the fallopian tube instead of the uterus). A tubal pregnancy is a medical emergency.

Less serious side effects may include:

• 
  

  nausea, diarrhea, or stomach pain;

  
  


• 
  

  dizziness, tired feeling;

  
  


• 
  

  breast pain or tenderness;

  
  


• 
  

  changes in your menstrual periods; or

  
  


• 
  

  headache.

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Next Choice (levonorgestrel emergency contraceptive)?

Before using this medication, tell your doctor if you are using any of the following drugs:

• 
  

  rifampin (Rifadin, Rifater, Rifamate, Rimactane);

  
  


• 
  

  a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton); or

  
  


• 
  

  seizure medicines such as phenytoin (Dilantin), or carbamazepine (Tegretol).

  
  

This list is not complete and there may be other drugs that can affect levonorgestrel emergency contraceptive. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

More Next Choice resources

• Next Choice Side Effects (in more detail)
• Next Choice Dosage
• Next Choice Use in Pregnancy & Breastfeeding
• Drug Images
• Next Choice Drug Interactions
• 2 Reviews for Next Choice - Add your own review/rating

• Next Choice Advanced Consumer (Micromedex) - Includes Dosage Information


• Next Choice Prescribing Information (FDA)


• Levonorgestrel MedFacts Consumer Leaflet (Wolters Kluwer)


• Levonorgestrel Professional Patient Advice (Wolters Kluwer)


• Mirena Prescribing Information (FDA)


• Mirena Consumer Overview


• Mirena Advanced Consumer (Micromedex) - Includes Dosage Information


• Mirena IUD MedFacts Consumer Leaflet (Wolters Kluwer)


• Plan B Prescribing Information (FDA)


• Plan B Consumer Overview


• Plan B One-Step Consumer Overview


• Plan B One-Step MedFacts Consumer Leaflet (Wolters Kluwer)


• Plan B One-Step Advanced Consumer (Micromedex) - Includes Dosage Information

Compare Next Choice with other medications

• Emergency Contraception

Where can I get more information?

• Your pharmacist can provide more information about levonorgestrel emergency contraceptive.

See also: Next Choice side effects (in more detail)